Breeze Database Information Form

Please help us update our church database.

Please fill out the form as completely as possible. A form is needed for each adult in a household.

After we receive your information, including your email address, you will receive an invitation to create your own username and password to access the St. Paul’s Membership Database.

Don’t have an email address? Print and fill out the form and return it to the church office. Membership Information Form for Breeze

Breeze Information Form

Date
MM slash DD slash YYYY
Name*
Prefix First Middle Last Suffix
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Email*
Birthdate
MM slash DD slash YYYY
Marital Status
- Single
- Married
- Divorced
- Widowed
- Domestic Partnership
Gender
- Male
- Female
- Prefer not to answer
Present Church Status
- Member
- Attender
- Friend
- Visitor
- Other
Are you Baptized?
- Yes
- No
Date of Baptism
MM slash DD slash YYYY
Children: Please list children living in your home
Full Name Birthdate Grade in School Baptized? Confirmed?

(Click + to add new line)
Other adults living at home - relationship to you
Occupation
Employer
Work Email Address
Skills
Spiritual Gifts
May St. Paul's UMC share your info with Members/Friends in the church directory?
- Yes
- No

Full Name	Birthdate	Grade in School	Baptized?	Confirmed?